Exam 1 Flashcards
Functions of the axial skeleton?
- support 2. movement 3. protection
What is the large flat piece of tendon associated with large flat muscles (ie. latissiumus dorsi, trapezius)?
aponeurosis
PAID for sternocleidomastoid
P.- proximal attachment
A.- Action
I.- Innervation
D.- distal attachment
P- mastoid process
A- unilateral contraction: head tilt to opposite side, bilateral: head flexion
I- CN XI, Accessory nerve
P- manubrium and inferior border clavicular head
What happens when an intervertebral disk is compressed and herniates?
The nucleus (jelly center) is pushed dorsally into the IVF (ligaments along ventral edge are too tough to push through), which impinges on one or both roots . depending on vertebral region , will cause numbness, pain, parathesia in different regions.
PAID for Levator scapulae
P.- proximal attachment
A.- Action
I.- Innervation
D.- distal attachment
P- transverse processes of upper cervical vertebrae
A- scapular elevation
I- dorsal scapular nerve
D- medial superior border of scapula
What is the spinal nerve composed of?
formed by union of ventral (motor) and dorsal (sensory) roots, therefore is a mixed nerve.
Where does the spinal cord exit the skull?
At the foramen magnum of the occipital bones of the skull
In ventral roots, visceral motor fibers innervate which types of muscles?
smooth, cardiac, and glands
How many sectional planes are there, and describe each
3 1. Frontal- anterior (ventral) /posterior (dorsal) 2. Sagittal (median)- left/right. parasagittal 3. Transverse- top and bottom
Bones in the vertebral arch?
pedicle, lamina, vertebral body
How many vertebra in each region along spine?
Cervical-7 Thoracic- 12 Lumbar-5 Sacral- 5 (fused) Coccygeal (4)
How many spinal enlargements are there, vertebral region, and why are they enlarged?
-2 - Cervical C4-T1 and Lumber L2-L3 - Enlargements represent increased neuronal density/activity as they supply the upper and lower limbs through the brachial and lumbosacral plexuses, respectively
What is the Conus Medullaris and its function?
located just below the lumbar enlargement, CM is a narrowing cone shaped area at the lumbar vertebral region that houses the Filum Terminale.
what extensions help anchor the SC to the dura mater ?
Denticulate ligaments
How many layers are there of superficial back muscles, and what muscles are contained in each?
2
Superficial extrinsic- trapezius, latissimus dorsi
deep extrinsic- levator scapulae, rhomboids (major and minor)
During a lumbar puncture procedure, 1. where is this performed, 2. why there?
- Below L-2 and the CM in the subarachnoid space. 2. injecting into the cauda equina minimizes and almost eliminates risk of puncturing the SC.
Function of Costal and demifacets?
attachment points of respective rib to costal and demifacet.
What components make up the CNS?
Brain and spine cord
Which nerves are located in the posterior triangle, and what type are they?
4 of 5 are cutaneous sensory nerves.
1 of 5 is mixed (sensory + motor)
Sensory only: supraclavicular, transverse cervical, great auricular, lesser occiptal
Senory + Motor: CN XI/Accessory nerve
What are the general type of muscles of the back?
superficial
intermediate
deep
What bones are contained in the axial skeleton?
Skull, Rib cage, vertebral column
In ventral roots, somatic motor fibers innervate which type of muscles?
skeletal , originating from neurons in the anterior horn.
What type of neurons do the dorsal horns contain in gray matter?
Sensory
PAID for Latissimus Dorsi
P.- proximal attachment
A.- Action
I.- Innervation
D.- distal attachment
P- lower thoracic spinous processes, iliac crest, inferior 3-4 ribs
A- adducts, internally rotates, and extends the arm at the glenohumeral joint
I- thoracodorsal nerve
D- anterior floor of the intertubercular groove of humerus
What are spinal ganglions and where are they located?
collection of neurons OUTSIDE the CNS in the IVF. ; atypical morphology in that their long axon can be divided into two parts along the cell body.
Where is the cervical plexus located, and its name?
Erb’s point, located along posterior border of SCM
How many different type of processes are in a typical vertebra? Describe their functions
3 1.Spinous process- movement; many muscle attachments. 2. Articular- *superior, movement, movement of vertebrae against one another. 3. Transverse- movement; “wings” muscle attachment
How and where do vertebrae associate and connect to one another?
Via a synovial joint along the inferior articular process of one vertebra and superior articular process of the adjacent vertebra
What is the Cauda Equina and its function?
“horse tail” - dorsal and ventral SN roots of the inferior segments of the conus medullaris that extend to their respective IVF; this includes the Filum Terminale
What is the difference in white and gray matter?
White matter is composed of bundles of ascending or descending myelinated fibers (think white sheath)
Gray matter is composed of neuronal cell bodies and glial cell bodies
True or False:
A patient with the varicella zoster virus will exhibit a generalized rash.
False:
The shingles virus usually follows a specific dermatome, which appears as a band or small strip; along one side of the body or face
P.A.I.D. for Trapezius
P.- proximal attachment
A.- Action
I.- Innervation
D.- distal attachment
P- cervical and thoracic spinous processes of spine
A- superior fibers: scapular elevation, middle fibers: scapular retraction, inferior fibers: scapular depression
I- Innervation: Accessory nerve (CN XI)
D- clavicle, acromion, scapular spine
Draw/label cross section of vertebral column
insert pic
What are the borders of the posterior triangle?
anterior: posterior border of SCM
base: superior border of clavicle
posterior: anterior border of the trapezius
roof: deep cervical fascia
floor: prevertebral fascia
How does the spinal cord receive its blood supply?
longitudinally by 1 anterior SA and two posterior SAs; supplemented by segmental arteries at each vertebral level
Which muscle is a key landmark of the neck for dividing it into two triangles and their names?
SCM
anterior and posterior triangles
What type of neurons are contained in the intermediate grey matter?
interneurons and sympathetic neurons
(ie. intermodeiolateral cell column (IML)
The vertebral column consists of how many vertebrae?
33
Where do MOST spinal nerves exit their respective vertebrae? which one are typical? how so? (hint: 2 oddities)
-Thoracic and lumbar SNs exit BELOW vertebrae. - 1. There are 7 cervical vertebrae, but 8 cervical SNs. 2. Cervical SNs exit ABOVE the vertebrae.
What does the film terminale do?
single filament that extends from conus medullaris through the middle of the caudal equina to attach to the coccyx.
what is contained within the intervertebral foramen and where is it located?
comprised of the inferior vertebral notch, spinal nerve (and DRG), and superior vertebral notch. located on either side of vertebral body and just below the articular process
What is the Filum Terminale?
“end filament” - single extension of the Pia mater/SC from CM that terminates at the coccyx, via the filum terminale externum (coccygeal ligament)
What type of neurons do the ventral horns contain?
motor
PAID for Rhomboids
P.- proximal attachment
A.- Action
I.- Innervation
D.- distal attachment
P- transverse processes of cervical vertebrae
A- scapular retraction
I- dorsal scapular nerve
D- medial border of scapula
Which back muscles are extrinisic, and what does that mean?
superficial and intermediate
extrinsic muscles are those that connect the axial skeleton to the appendicular
Name/describe the meninges; superficial to deep
- dura mater (outermost)- hard outer covering of SC that extends to S2 level. 2. arachnoid membrane- avascular membrane depth the DM extends also to S2. subarachnoid space filled with CSF where SC floats 3. pia mater. single cell layer thick, adherent to SC.
Where is anesthesia placed for females in active labor?
In the epidural lumbar space under L2
Define anatomical position.
Standing erect with palms facing forward.
Which back muscles are intrinsic, and what does that mean?
deep back muscles
intrinsic muscles are those that connect axial to axial skeletons
What vertebral level does the spinal cord terminate in adults and infants?
L1-L2 in adults L3 in infants
What structures are used as landmarks to locate the brachial plexus deep in the posterior triangle?
The middle and anterior scalene muscles
When viewed from a SUPERIOR view, what are the anterior, medial, and posterior borders of the axilla?
Anterior: clavicle
medial: rib 1
posterior: scapula
From a SUPERIOR view, what muscles form the anterior, posterior, and medial walls of the axilla?
Anterior: pectoralis major, minor
Posterior: subscapularis, latissimus dorsi, and teres major
Medial: serratus anterior, intercostals
What artery is associated with the brachial plexus as it passes through the axilla, and what is the name of the bp as it does so?
axillary artery, cords
what landmark of the upper limb is used to denote the name change of the axillary artery to the brachial a?
lower border of the teres major
The axillary artery is divided into how many parts, and what muscle overlaps?
3, pectorialis minor
How many divisions are there in the divided axillary artery, and what is a good tip to remembering this?
3 divisions
The number of divisions is equal the number of branches in each division.
What nerve innervates the levator scapulae and rhomboids minor and major?
dorsal scapular (C5)
What connective structure forms and separates the forearm compartments (2)?
Invaginations of the antebrachial fascia and interosseous membrane
What does the antebrachial fascia do?
Surrounds the forearm with a thick connective tissue that protects all the structures in the forearm, along with separating the FA into anterior and posterior compartments
What is the major innervator for the flexor/anterior compartment of the forearm, with a few exceptions?
Median nerve
P.A.I.D. for Pronator Teres
P: medial epicondyle
A: pronates wrist
I. median n.
D.: Radius
P.A.I.D. for Flexor carpi radialis
P.: medial epiondyle
A.: flexes wrist, aBducts hand
I. median n.
D.: 2nd metacarpal
P.A.I.D. for Palmaris longus
P.: medial epicondyle
A.: flexes wrist, tenses palmar aponeurosis
I.: median n.
D. palmar aponeurosis
P.A.I.D. for Flexor carpi ulnaris
P.: medial epicondyle
A.: adDucts wrist, flexes wrist
I. ulnar n.
D.: 5th metacarpal, hook of hamate, pisiform
P.A.I.D. for Flexor digitorum superficialis
P- medial epicondyle
A- flexes proximal and middle phalangeal joints, digits 2-5
I- median n.
D.- middle phalangeal joints of digits 2-5
P.A.I.D. for Brachioradialis
P: lateral epicondyle
A: flexes forearm
I: radial n.
D: styloid process of radius
What anterior compartment muscles of the forearm are superficial?
Pronator teres
flexor carpi radialis
flexor carpi ulnaris
palmaris longus
flexor digitorum superficialis
brachioradialis*- can be in either anterior or posterior compartments
What anterior compartment muscles of the forearm are in the deep group?
flexor digitorum profundus
flexor pollicis longus
pronator quadratus
What posterior compartment muscles of the forearm are in the supeficial group?
extensor carpi radialis longus
extensor carpi radialis brevis
extensor digitorum
extensor digiti minimi
extensor carpi ulnaris
What are two structures that keep the long tendons of the hand in place?
Hint: they act much like the flexor retinaculum in the wrist.
- Osseofibrous tunnel over each finger
- synovial membrane bands that are attached both close to tendon attachments (DIP,PIP,MCP), but also proximally
vincula breve, vinculum longum
What posterior compartment extensor muscles of the forearm belong to the deep group?
Supinator
abductor pollicis longus
extensor pollicis brevis
extensor pollicis longus
extensor indicis
What are the major blood vessels of the forearm?
proximal to distal- stop before hand
Brachial artery bifurcates to
- radial a. (lateral)
- Ulnar a. (medial)
- Common interosseous a.
- Anterior interosseous a
- Posterior interosseous a. (dives through IM ligament gap
- Common interosseous a.
What innervates the flexor compartment of the forearm?
Median nerve except for 2;
Ulnar n. : flexor carpi ulnaris and 1/2 flexor digitorum profundus
What innverates the posterior compartment of the forearm?
Radial nerve
Which 3 muscles form the anatomical snuff box?
extensor pollicis longus
ext. pollicis brevis
abductor pollicis brevis
